Module II: Diagnosing Paediatric HIV

Key Questions:• How and where do we identify HIV exposed and

infected infants and children?

• What HIV tests should be done on which children and when?

• What are common symptoms of HIV exposed and infected children?

• What tool can I use to correctly diagnose and test children?

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Infants are most severely affected by HIV infection.Infants respond well to treatment if identified early enough.

Without diagnosis and treatment, infants die

At 1 year 30%

At 2 year 50%

At 5 year66 – 75%

At 10 years

85%

Mortality Rates for Mortality Rates for untreated children with untreated children with

HIVHIV

Put into real numbers…

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Birth

1 ye

ar

2 ye

ars

10 ye

ars

If 10 positive children are born and none get care…

But early diagnosis and treatment decreases AIDS-related pediatric

mortality by 75%

by allowing us to diagnose children before they get sick.

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Where do we identify HIV infected and exposed children from?

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ANC/PMTCT services

Paed wards

Paediatric HIV-Care

Adult HIV Services (HIV

Care, VCT)

Paediatric OPD

Lower level health facilities

Community:OVC Support Services, Support Groups & PLHA

AssociationsCBOs/NGOs/FBOs, Women groups

Maternity (at birth)PNC

Nutrition Unit

Exposed infants can & should be captured at many different points within a health facility

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Summary of the process for proactively identifying HIV-exposed infants infants

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Activity: Diagnosis and Testing for different age groupsGroups 1 & 2: Infants to <18 monthsGroups 3 & 4: > 18 months

Task: Each group will answer the following questions for your assigned age:

• Who should be tested?• When should they be tested?• Which tests should be done?

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Who needs to test?

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All children with an HIV+ MOM

TRR

Who needs to test?

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All children with UNKNOWN status

Who needs to test?

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1. HIV doubles the energy needs of our bodies, causing weight loss.

2. A weakened immune system results in infections.

Any child, especially those who are sick with signs of possible HIV

(even if previously tested negative)

SICK

Molluscum Contagiosum

Generalized lymph node enlargement (swelling)

Ear infections

Dental Caries

Severe Wasting Stunted Growth

3 yrs old

Common signs and symptoms of HIV in exposed babies

Photos from MOH, Uganda EID training

program (2010)04/19/23 MOH-Paediatric HIV/AIDS training for

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Skin lesions (common in Kaposi’s Sarcoma) Oral Thrush

Fungal InfectionsHerpes Zoster

Skin Rash

Common signs and symptoms of HIV in exposed babies

Photos from MOH, Uganda EID training program

(2010)

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What’s in a drop of blood in someone

with HIV?Antibodies (body’s reaction to the virus)

HIV virus

Mom’s Antibodies

Baby’s Antibodies

In a child < 18m both mom and baby antibodies can be present

6 weeks to <18 months 18 months and above

DNA PCR using Dry Blood Spot (DBS)

(Virologic)

Serial Rapid Tests

(Antibody)

Which test should you use?Choose based on child’s age

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The definitive diagnosis of HIV infection in children at any age requires diagnostic testing that confirms the presence of HIV.

Activity: Using the HIV Testing Algorithm to take appropriate actions

Use the Testing Algorithm to answer the following questions:

1. Why and when would you perform a rapid test on an infant?

2. You have a confirmed HIV+ mother who is still breastfeeding, and the exposed infant’s first PCR was negative, what should you do next and when?

3. Is one positive PCR test enough to start a child on ART?

Diagnosis & Testing Practice Case #1

A 3.5 month old child comes to YCC for immunization.

a) How do you go about determining the exposure status of the child?

b) If the child is HIV exposed what test do you do?

c) If the test is positive what would you do?

d) If the test is negative what would you do?

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Diagnosis & Testing Practice Case #2

You have a 2 year old child who presents in OPD with oral thrush

a)What test would you use to diagnose HIV in this child?

b) If it is negative what would you do?

c) If it is positive what would you do?

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You should never let a mother leave the health center without trying to determine

her infant’s HIV exposure status

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1. PREVENT EARLY

2. TEST EARLY

3. TREAT EARLY

We can make a difference!

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PMTCT

Pro-active HTC

ARVs

For those HIV infections that we cannot prevent,

we CAN identify them early and keep them healthy.

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